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STI treatment guidelines

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STI PREFERRED TREATMENT – TREATMENT CONDITIONS FOLLOW-UP
RECOMMENDED REGIMEN PREGNANCY REGIMEN PENICILLIN ALLERGY
CHLAMYDIA Azithromycin 1 g po Stat in single dose if poor compliance is expected
OR
Doxycycline 100 mg po bid for 7 days
ALTERNATIVE
Ofloxacin 300 mg po bid for 7 days
OR
Erythromycin 2 g/day po in divided doses for 7 days
OR
Erythromycin 1 g/day po in divided doses for 14 days
Azithromycin 1 g po in a single dose if poor compliance is expected
OR
Amoxicillin 500 mg po tid for 7 days
OR
Erythromycin 2 g/day po in divided doses for 7 days
OR
Erythromycin 1 g/day po in divided doses for 14 days
Same as recommended treatment regimen. Test of cure should be performed 3-4 weeks after treatment for all pregnant women and nursing mothers who have used erythromycin or amoxicillin.
All other clients only require a 6 month repeat test.
GONORRHEA First Line Therapy:
Ceftriaxone 250 mg IM Stat + Azithromycin 1 g po Stat
Alternate Therapy to be considered if first line therapy is not available or allergies exist:
Cefixime 400 mg po Stat + Azithromycin 1 g po Stat
OR
Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat
OR
Azithromycin 2 g po Stat
First Line Therapy:
Ceftriaxone 250 mg IM Stat + Azithromycin 1 g po Stat
Alternate Therapy to be considered if first line therapy is not available or allergies exist:
Cefixime 400 mg po Stat + Azithromycin 1 g po Stat
OR
Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat
OR
Azithromycin 2 g po Stat
Spectinomycin 2 g IM Stat + Azithromycin 1 g po Stat
OR
Azithromycin 2 g po Stat
Test of Cure
If pharyngeal/rectal infection, pregnancy, potential susceptibility, or potential treatment failure:

  • Culture >4 days post treatment (preferred)
  • NAAT 2 weeks post treatment (alternative)

If none of the above have occurred, rescreen 6 months post treatment for potential repeat infection

PID Regimen A:
Ceftriaxone 250 mg IM in a single dose PLUS doxycycline 100mg po bid for 14 days
OR
Cefoxitin 2 g IM PLUS probenecid 1 g po in a single dose concurrently once PLUS doxycycline 100 mg po bid for 14 days
Many authorities recommend the addition of metronidazole 500 mg po bid for 14 days to this regimen for additional anaerobic coverage and treatment of bacterial vaginosis
Regimen B:
Ofloxacin 400 mg po bid for 14 days PLUS/MINUS metronidazole 500 mg po bid for 14 days
OR
Levofloxacin 500 mg po qd PLUS/MINUS metronidazole 500 mg po bid for 14 days
Pregnant women with suspected PID should be
hospitalized for evaluation
Individuals receiving outpatient therapy should be re-evaluated 2-3 days after treatment has been initiated. If no clinical improvement, hospital admission is required.
EPIDIDYMITIS Doxycycline 100 mg po bid for 10-14 days
PLUS
Ceftriaxone 250 mg IM in a single dose
OR
Ciprofloxacin 500 mg po in a single dose
(unless not recommended due to quinolone resistence)
Azithromycin 2 g PO in a single dose Retest post treatment
if compliance is uncertain
or if alternative treatment is used.
SYPHILIS Primary, secondary, early latent, less than 1
year duration:
Benzathine Penicillin G 2.4 million U IM in a single session
Late latent, more than 1 year of indeterminate duration:
Benzathine Penicillin G 2.4 million U IM once/week for 3 successive weeks
(Call the Sexual Health Clinic to obtain.)
Primary, secondary, early latent:
Benzathine Penicillan G 2.4 million units IM weekly for 1-2 doses
There is no satisfactory alternative to penicillin for
the treatment of syphilis in pregnancy; strongly consider penicillin desensitization followed by treatment with penicillin
Late Latent:
Benzathine Penicillin G 2.4 million units IM weekly for 3 doses
Strongly consider penicillin desensitization.
Primary, secondary, early latent:
Doxycycline 100 mg po bid for 14 days
Ceftriaxone 1 g IV or IM daily for 10 days
Late Latent:
Doxycycline 100 mg po bid for 28 days
Ceftriaxone 1 g IV or IM daily for 10 days
For primary, secondary
and early latent:
repeat serology at 1, 3, 6, and 12 months after treatment.
For late latent:
repeat serology 12 and 24 months after treatment.
LGV
(Lymphogranuloma venerum)
Doxycycline 100 mg po bid for 21 days
ALTERNATIVE
Erythromycin 500 mg po qid for 21 days
Possibly, Azithromycin 1 g po once weekly for 3 weeks
Erythromycin base 500 mg orally 4 times a day x 21 days
Azithromycin 1 g orally for 3 weeks (may be
effective, but not proven)
Erythromycin base 500 mg orally four times
a day x 21 days (DO NOT use estolate formulation
in pregnancy)
Test of cure should be repeated until tests are negative and patient has
recovered.

Adapted with permission from Niagara Region Public Health Department, Halton Region Health Department and from the 2008 STD (Canadian) Guidelines Updated July 2013.

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